pancrelipase

pancrelipase

a preparation of hog pancreas containing enzymes, principally amylase, protease, and lipase; used as a digestive aid in treatment of pancreatic insufficiency.

pancrelipase

Creon, Pancreaze, Ultresa, Viokace, Zenpep

Pharmacologic class: Pancreatic enzyme

Therapeutic class: Digestant

Pregnancy risk category C

Action

Catalyzes hydrolysis of fats to mono-glyceride, glycerol, and free fatty acids; proteins into peptides and amino acids; and starches into dextrins and short chain sugars, such as maltose and maltriose, in the duodenum and proximal small intestine, thereby acting like digestive enzymes physiologically secreted by the pancreas

Adults and children age 4 and older: Initially, 500 lipase units/kg/meal to a maximum of 2,500 lipase units/kg/meal (or 10,000 lipase units/kg/day or less), or less than 4,000 lipase units/g fat ingested per day (Creon)

Children older than age 12 months and younger than age 4: Initially, 1,000 lipase units/kg/meal to a maximum of 2,500 lipase units/kg/meal (or 10,000 lipase units/kg/day or less), or less than 4,000 lipase units/g fat ingested per day (Creon)

Infants up to age 12 months: 3,000 lipase units/120 ml formula or per breastfeeding (Creon)

Adults and children age 4 and older: Initially, 500 lipase units/kg/meal to a maximum of 2,500 lipase units/kg/meal (or 10,000 lipase units/kg/day or less), or less than 4,000 lipase units/g fat ingested per day (Pancreaze, Zenpep)

Adults and children age 4 and older weighing 28 kg (62 lb) or more: Initially, 500 lipase units/kg/meal to a maximum of 2,500 lipase units/kg/meal (or 10,000 lipase units/kg/day or less), or less than 4,000 lipase units/g fat ingested per day (Ultresa)

Children older than age 12 months and younger than age 4: Initially, 1,000 lipase units/kg/meal to a maximum of 2,500 lipase units/kg/meal (or 10,000 lipase units/kg/day or less), or less than 4,000 lipase units/g fat ingested per day (Pancreaze, Zenpep)

Children older than age 12 months and younger than age 4 weighing 14 kg (31 lb) or more: Initially, 1,000 lipase units/kg/meal to a maximum of 2,500 lipase units/kg/meal (or 10,000 lipase units/kg/day or less), or less than 4,000 lipase units/g fat ingested per day (Ultresa)

Infants up to age 12 months: 2,000 to 4,000 lipase units/120 ml formula or per breastfeeding (Pancreaze); 3,000 lipase units/120 ml formula or per breastfeeding (Zenpep)

• Be aware that attempting to divide capsule contents into small fractions to deliver small doses of lipase isn't recommended.

• Be aware that high-dose use (exceeding 6,000 lipase units/kg/meal) of pancreatic enzyme replacement therapy has been associated with fibrosing colonopathy and colonic strictures in children younger than age 12.

Interactions

None

Patient monitoring

• Monitor patient for hyperglycemia, hypoglycemia, and hyperuricemia.

☞ Closely monitor patient for signs or symptoms of fibrosing colonopathy (such as abdominal pain or distention, vomiting, intermittent diarrhea, and weight loss) that may be associated with high-dose use.

Patient teaching

• Tell patient or caregiver that capsules must be swallowed whole and shouldn't be crushed or chewed.

• Advise patient or caregiver to take drug with food with a full glass of water.

• Tell patient or caregiver not to hold drug in mouth, to avoid mucosal irritation.

• Tell patient or caregiver that for infants or patients who are unable to swallow intact capsules, contents can be sprinkled on soft acidic food, such as applesauce, yogurt, or other soft acidic food.

• Tell patient or caregiver not to mix capsule contents with alkaline foods, such as milk, breast milk, formula, or ice cream.

• Instruct patient or caregiver to report signs or symptoms of high blood sugar (such as extreme thirst), low blood sugar (such as confusion, shakiness, sweating, or hunger), or high uric acid (pain or swelling around joints).

• Advise breastfeeding patient to consider risk and benefit of drug in providing adequate nutritional support for exocrine pancreatic insufficiency.

• Advise female of childbearing age to notify prescriber if she is pregnant, thinking of becoming pregnant, or is breastfeeding during therapy.

• As appropriate, review all other significant and life-threatening adverse reactions.

pan·cre·li·pase

(pan-krē-lī'pās),

A concentrate of pancreatic enzymes standardized for lipase content; a lipolytic used for substitution therapy.

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